Psyched about medical psychedelics? New centre aims to meet demand from docs looking to learn more

The launch last month of the Nikean Psychedelic Psychotherapy Research Centre at University Health Network in Toronto gives doctors eager to learn more about psychedelic medicine something to look forward to. Backed by a $5-million grant from tech entrepreneur Sanjay Singhal, the new centre plans to provide education on psychedelic medicines to family doctors, specialists, psychotherapists and other healthcare professionals who “want to know more than their patients do about psychedelics,” Dr. Susan Abbey, the new centre’s director, told The Medical Post. "We're running our first general interest course–a survey course–in first three months of the new year," she said. "There's so much interest in the subject. In the U.S., during a 2020 annual meeting of American psychologists they ended up spending two-and-a-half days talking about psychedelics because excitement about it is so high." The centre also has plans to launch a training program on psychedelic-assisted therapy for researchers looking to work as part of the centre’s study team. Dr. Abbey said the centre is also getting ready to lead what may be Canada’s first clinical study of psilocybin-assisted therapy for patients dealing with end-of-life distress. This study, which the centre anticipates will start in the summer of 2022, will work with palliative cancer patients at Princess Margaret Cancer Centre and Toronto General Hospital. It makes sense to focus the centre’s initial studies on patients with terminal cancer because data already exists on the use of a therapy called Managing Cancer and Living Meaningfully–also known as CALM–to address end-of-life distress, said Dr. Abbey. “A lot of people have already reached out asking to sign up for our studies, even though we’re still in very, very early stages,” she added. Read: What we know (and what we don't) about clinical use of psychedelic drugs Psychedelic medicine education for doctors is more critical than ever because patients are increasingly asking about substances such as psilocybin, ketamine, LSD and MDMA, said Dr. Pam Kryskow, a Vancouver-based family physician and board member of the Canadian Psychedelic Association, a not-for-profit organization that connects physicians, mental health professionals and other healthcare professionals to the latest research and training in psychedelic medicine. The challenge for doctors will be sifting through the growing body of research in psychedelic medicine and keeping abreast of regulatory shifts. Globally there 76 registered studies on psilocybin, 123 on LSD, 102 on MDMA, three on ibogaine and two on ayahuasca. There are 1,125 clinical studies on ketamine but these include investigations into other applications, such as anesthesia, cardiovascular health and post-cancer pain. “Like everything else in medicine the first thing to do is get educated about this,” said Dr. Kryskow. “For physicians who are already so pressed for time it’s hard to stay on top of everything, but there are a number of credible and trustworthy sources where you can review the latest research and fill in the blanks in your knowledge.” Read: MDMA shows promise as PTSD treatment aid Beyond the science, physicians need to understand the legalities around psychedelics. Today ketamine is the only psychedelic approved for legal medical use, although the cost for ketamine treatments for mental health conditions such as depression isn't covered by provincial health plans. When it comes to psilocybin, the only way patients can get the hallucinogenic compound found in magic mushrooms is if the country’s Health Minister grants them an exemption under Section 56 of the Controlled Drugs and Substances Act. As media shines a brighter light on the use of psilocybin in end-of-life and extreme pain situations, such as with patients who suffer from cluster migraines, doctors can expect to start seeing more requests for Section 56 exemptions, said Spencer Hawkswell, CEO at TheraPsil, a non-profit group that helps patients get access to legal psilocybin-assisted psychotherapy. So far TheraPsil has helped about 45 Canadians get Section 56 exemptions, mostly for end-of-life distress. The group has also supported about 20 doctors with their applications to use psilocybin for training purposes. But Section 56 should not be the pathway to access psilocybin or any other evidence-backed psychedelic medicine, said Hawkswell. “We are asserting to government that Section 56 is not a good way to get people access to medicine in this country,” he said. “We need regulation much like what exists with cannabis, where the doctor is the gatekeeper and where patients can access psilocybin that’s grown properly.” Dr. Kryskow agreed. The problem with getting access through Section 56, she said, is that the decision to grant or deny access is made not by a patient’s physician but by the country’s health minister. Even when access is granted, patients must source their own psychedelics. This creates a Catch 22: to be able to exercise a legally granted exemption, patients–and, in some cases, their doctors–must break the law. This also puts patients at risk of ending up with a product that’s either inefficacious or unsafe. “It’s not a good process for anyone,” said Dr. Kryskow. “Instead of that decision being made between a well-informed physician and a patient, the physician has to get permission from the health minister of Canada.” Read: Where do 'magic mushrooms' belong in patient treatment? This also means paperwork for the physician requesting a Section 56 exemption. Not many doctors have the time nor the inclination to take on this administrative burden, especially when they feel they should be focusing on ways to better support their patients, said Hawkswell. So far close to 30 doctors have gone through training at TheraPsil to learn how to help patients with psilocybin-assisted therapy, he added. This training includes information on drug interactions, indications and contraindications for psilocybin. Physicians’ demand for this training has been strong, said Hawkswell, and TheraPsil has been overwhelmed and working hard to keep up. The hope is that as more doctors get educated on psychedelic medicines, colleges will start to define protocols for psychedelic-assisted therapy, said Hawkswell. “We want to create foundations for doctors and therapists that will allow them to prove to their college that they’ve done training and are following generally accepted uses for the substance among the community of practice,” he said. The opening of the Nikean Psychedelic Psychotherapy Research gives doctors more options for training in psychedelic medicine and psychedelic-assisted therapy. More options are underway. Dr. Kryskow pointed to a post-graduate certificate in psychedelic-assisted therapy set to launch next year at Vancouver Island University in collaboration with the University of Ottawa. There’s also more Canadian research coming. Earlier this year the University of Calgary announced new research chairs in psychedelics while the University of Toronto rolled out a psychedelic studies research program. Dr. Abbey urges physicians to get educated in this resurgent field. “Our patients want us to know about psychedelics,” she said. “For many patients it’s incredibly helpful to know that there’s hope for them, that there’s work being done in the space that could lead to better treatments tomorrow.” Read: Psychedelic drugs for treatment of mental illness focus of UofC research chair

Psyched about medical psychedelics? New centre aims to meet demand from docs looking to learn more

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